Which ICU should I work in?

[NCRNMDM, ASN, RN]

First and foremost, I'm not sure if this question belongs here, so feel free to move it if it's in the wrong place. Secondly, I'm starting nursing school in August, and I already know that I want to be an ICU nurse. I have volunteered and worked as a CNA in both the ICU and the ER and, while I loved both environments, I know that the ICU is the place for me. The one question that I can't seem to answer is which unit should I work in. I like the broad-spectrum aspects of medical intensive care, and the fact that you have to know so much about all kinds of disease processes and diagnoses to work there, however I like the idea of specializing in a more focused unit, like CVICU or neurosurgical ICU. I am a total adrenaline junky, but I am burnt out on the ED and I know that I want to spend more time with my patients and their family, and connect with them on a deeper level than is possible in the ED. I would have no problem working in the following ICUs: PICU, MICU, SICU, BICU, neurosurgical ICU, CVICU, or trauma ICU. So, your thoughts, comments, and input would be greatly appreciated. Give me the good, bad, and the ugly about these units, and tell me the pros and cons, and the things you wish you had known before you started. Thank you!

[TiffyRN, BSN, PhD]

I'm sorry that I do not have the experience to speak on any of they units you mentioned. I will say this. Before I started nursing school, I thought I wanted to work on the mother/baby unit or L&D. After my rotation in mother/baby I knew I wanted nothing to do with that specialty (well, the mother part anyway). When I graduated I thought maybe hospice but at the time in our small town, there wasn't really such a specialty and by the time there was, I had established myself somewhere else. I have cared for many patients since that qualified for hospice and I believe I provide them great care, but those cases really rip me up and I don't think I could do that full-time.

Message being; you are doing the right thing by gathering information but contact with actual patients is the most important thing.

[AgentBeast, BSN, RN]

Worry about finishing nursing school and passing the NCLEX first.

[meandragonbrett]

Get yourself through nursing school. Also, don't think that all of the other ICUs don't also care for medical issues. They all take care of sepsis, DKA, hyperkalemia, pneumonia, resp. failure, GI bleeds etc. It's just complicated by surgical procedures, trauma, a head injury, etc.

[shhhh]

Nowadays, it's rare that a nursing student gets accepted into an ICU internship right out of nursing school. My unit has declined to offer positions to soon-to-be graduating nursing students who've done months of their senior practicum on our unit in favor of nurses who've had a few years of med/surg under their belt. So, like ScottE said, worry about finishing nursing school, passing the NCLEX, (and here's my addition) get at least a year experience of med/surg.

But I'll stop being a jerk and answer your question... Whatever ICU specialty you choose doesn't really matter, because you can count on floating to every single ICU at your hospital VERY frequently!

[Tait, MSN, RN]

I work cardiac/med-surg. If I were to go into the ICU I would love to get into cardiac (CCU). I just

[RNperdiem, RN]

I have experience in all those units.

I'm not telling you where to work, just giving my own personal opinions.

My favorites are SICU, CVICU and Cardiac ICU. The patients there tend to do well. MICU is a bit down the scale on favorites-more chronic conditions, contact isolation.

Neuro and Burns I don't like to float to. Both units have a high "tragedy" factor.

[Turd Ferguson]

It's great that you have done your research and know what you're interested in, however don't let that get in the way of your clinical experiences in nursing school. I saw too many fellow students give a half-hearted effort on certain floors because that wasn't what they were interested in. Go in with an open mind and learn/experience as much as you can, you'd be surprised what you can learn on a good old med surg floor.

[mmwatkin]

Why not try them all and see what you like best? The hospitals in my area have a "rotation program" where you can rotate through vascular, burn, cticu, trauma, neuro, micu, picu, ccu, er, pacu and bid for a job where you like/ fit in! No one know until you try it!

[Jenni811, RN]

good luck getting a job as a new grad in the ICU. Even having worked as a CNA in ICU/ER. Employers could care less about that because they are different jobs.

Just saying...you're better of starting somewhere like a med/surg floor, get some experience then move up. ICU nurses and ER nurses tend to eat alive someone who doesn't know what they are doing. They are not bad people, they just know their s*** and expect that you do too if you are going to apart of their "team." I would 99% of our nurses in our ICU and experience elsewhere.

Best of luck to that...just don't want you to get discouraged :)

[313RN, BSN, RN]

Now see, I work in a large urban hospital system and the ICU's here Grad Nurses regularly. I was a GN when I started, and two of my classmates started with me (one on my unit- NeuroICU and one in MICU). Two others went to ICU as well, one in NeuroTrauma and one in MICU in another system. That's 5 in a graduating class of about 37. So it's very possible, depending on where you live.

The downside of taking GN's for us is the high turn over. Many leave within a year or two to become CRNA's or NPs. Management is fine with that.

Recently they have decided that they will only bring on GN's who are licensed. I was interviewed a couple of days after I took my NCLEX and showed up on day one with my license. The unit preceptors all ntoed that having a licenesed preceptee (both me and my classmates) made orientation much easier.

You can do the job right out of school as loong as the orientation is good. Mine was 12 weeks of classroom and precepting before going on my own for a month on days. After that we sent to the shifts for which we were hired.

As to where to go, I like Neuro and Surguical best, then MICU, CICU and Stepdown. Alot of that has more to do with staff than patients. We take a lot of medical and some surgical overflow on my unit and get pulled regularly.

I don't care for CICU much simply because I don't do it enough to feel comfortable with swans and cordis's etc.

You've got plenty of time to figure it out. Good luck.